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DATE RECEIVED <br /> SAN JOAQUINLINTY <br /> . 'rA1804 F-Weber Ave 3� Floor Stockton, CA 95205 <br /> Fax: 09 464-0138 Web: wNvw.co.san-joaquin.ca.us/ehd L4 <br /> 03 G 13 Ali##IMLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C—14 le—/Z BUSINESSIAGENCY: <br /> ADDRESS: � �1t3 4 Vic' <br /> PHONE- FACSIMILE: <br /> TE ' ATt� APt + Tlre:I <br /> (Please allow 10 business days from date of applicationsubmittal) <br /> CHECK BOX TO EXPEOtTE REQUEST 3.00 FEERE t EST PR CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE, OF APPLICANT '° ., _._ :� � � DATE <br /> Department Use Only <br /> UMT <br /> FIL DRESS <br /> 0. Unit Ir <br /> Cit <br /> S4 S } rnl Lt err Unit <br /> sh _ ems. _ <br /> e' ..o.„...... "' UnItAi <br /> €r <br /> a Street. - __ _ _—._w _�. .."....."......._... ...... "�.... <br /> 10 Strut <br /> ENVIRONl lENTAL HEALTH DEPARTMENILES <br /> �M <br /> w4r)E C3fiOUN TANK(t1S")CLFAINUP SITE(LCT) 0 iiOUSjIV G ABATEMENT 03 SOLiD W. �� l�lW <br /> HER Lu'r^ SITE t rr} r> i" �OOD FACILITY" — � �I_ttI'�N' 'l'VEF1JC <br /> UNDERGROUND TANK NN G;REMOVAL) 0 DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENE'RATOR F1 CHICKEN RANCH PKG TREATIM. NT PLAN T <br /> TiEREC3PERIM `ITED FA I'LiTY 0 MOTELIHOTEl 0 PUNIPERTRUCIOVAAMNIE.dl r EIS. <br /> iP BODY PIERCING F" <br /> r'.':.' . . I' C�OL.!$PA C� Ld�PII <br /> aCJC7 us AJ*LtCI� ,sL' s <br /> 0 tVI E M AL WASTE AC LLI'1'1t'... .. l OTHER(PLEASE SPECIFY) <br /> 1 List up to ten addresses 16tho Space above# Select the type(s)of files from the list a$3o a bit#:heclLino <br /> tl to a ro , i to>i r�c es • At,le east one f:ie t e l�YrlUST be seletted. pax tcs � 4 0138 er j6 �ttte <br /> € t Yp �_ <br /> lr3re l �i,cde. <br /> 2. <br /> EHD will notlt Ie l0 111tant-If any 151.40.fitos exist. An appointment for review w0l be om*44 <br /> re x r ately five bu ll ess<dIlya- <br /> appt' It no liter than ton (10) days atter receipt sof a pl catEon. 'Fite filar <br /> i I I lie h e I d for a max1inurrL:d five.ttLasiness days for review. Appolihtmiehts should be:Scheduled <br /> Accor lin t} <br /> 3> f i that�s t elyWi,9 woiked on by H D staff may not be Immediately avail abto d rertlew. Anew <br /> Ication may:l�e eta.mitte+d t�tltera the file is available. <br /> 4 l�,ny file nc�t retcL. d iri the sable c nditi+on as released will be reorganized HO staf ..t the exio-n <br /> -6f the ap rlteal�tt. l 0durefile reviews by tete same applicant may require a$93 dep€�sltprle►r to rerviernr. <br /> ��ATENTATIV'E appl�trnertt dates dnL6St be confirmed with l�H1l staff. <br /> 411 �Ap iic tscns rc eived after S.M. pm Will be processed the next business iday: <br /> _.._ <br /> CONFIRME01' . ENT DAA TIME <br /> OATS�C?NFiit�1151�` .. ... PHONE .. .. il+l�`IALS <br /> Ftl Vii tlW l YES. : NO . REVIEW DAT <br />